'A possible NMC fee hike will not prove popular with registrants who feel let down'

The news that a possible fee hike could be on the cards at the Nursing and Midwifery Council will not be proving popular with registrants who feel let down by their regulator in recent years.

But if it is to tackle a backlog of 4,000 fitness to practise cases, there is probably little else the regulator can do than increase the number of cases it sees – and that is going to cost.

Suggestions of a fee rise were made by acting NMC chief executive Jackie Smith following an interim report into the regulator by the Council for Healthcare Regulatory Excellence last week. She said that a fee rise could not be ruled out while the NMC paused, or stopped, anything that was “non-essential” to focus on these cases.

Nurses will be understandably angry that it’s they that will pay the price for a regulator that failed to prioritise how best to spend their registration fees, letting the cases stack up while it launched its personal crusade to increase its reach and influence.

The regulator has been distracted by topics such as mandatory healthcare assistant regulation, while the FtP cases piled up in its in-tray. Most believe that tightening controls on healthcare support workers is an essential part of improving care provision and public confidence in nursing, but the NMC’s existing problems suggest it was not in the best place to take on this extra function.

The CHRE report has called into question the abilities of those leading the NMC during the period in question – and it’s not the first time that NMC personnel have found themselves in the spotlight when the regulator has been found wanting. But thankfully (if somewhat surprisingly) there is no shortage of senior nurses I have spoken to who are willing to take on what’s seen as a somewhat poisoned chalice to sort out this organisation for the good of the profession.

Cue the new temporary chair – Judith Ellis. Already holding down a job as executive dean at London South Bank University, she has now stepped up from the NMC board to try and transform it from the top. What she needs to do is restore the confidence of the public in nursing, but also the confidence of nurses in their regulator. The profession is holding its breath.

Readers' comments
(56)

Anonymous | 10-Apr-2012 2:38 pm

It might help if they were more efficient, less bureaucratic, less pompous, and far less up themselves! They waste millions of £s faffing about, repeating themselves, failing to respond, losing paperwork, patronising their clients and generally being relatively useless. The increase in fees is an outrage coming as it does on the back of gross inefficiency and lack of leadership.

Increasing living costs, the pay freezes, an increase in pension contributions plus a risk of redundancy and now a possible increase in NMC fees... Life is really hard at the moment and it's all very depressing.

I have one question, before the NMC increases the annual fee. What exactly do they do for Nurses and Midwives?I think the Nurses and Midwives should ahve access to see where the money goes, what budget is for what.Additionally I believe NMC, do not support Nurses and Midwives. The standards of care in the UK is appauling to say the least, the cutting of staff is encouraging many Nurses and Midwives to leave the profession,I believe it is aboit time, the NMC devised a safe Nurse-Patient ratio like every other developed country Nursing Professional Registry has done for their fellow colleagues. This leaves Nurses and Midwives with no back-up, basic standards, and minimal requirements. I have seen me on many day having the responsibility to care for 10-12 patients independently (This is not safe). In the US, the maximum number of patients per nurse is 4,on a bad day 5.This is non-HDU/ICU. This is a regular ward, but I asked the NMC once on the telephone what they believe to be safe and my answer was well they dont offer such advice. So it is in times like this I wonder what exactly they do for us?

surely consideration must be given to the fact of pay freezes, job insecurity, increased in pension contributions, as the person above i do not feel that the nmc offers anything to the nursing profession and perhaps we are in need of a new governing body - and one that works for its paying clients. Many nurses are in unions and pay monthly fees, so if we do have to pay - the so called governing body - then pay monthly so it is not such a huge chunk out of an already dwindling salary.

I have one question, before the NMC increases the annual fee. What exactly do they do for Nurses and Midwives?I think the Nurses and Midwives should have access to see where the money goes, what budget is for what.Additionally I believe NMC, do not support Nurses and Midwives. The standards of care in the UK is appauling to say the least, the cutting of staff is encouraging many Nurses and Midwives to leave the profession,I believe it is about time, the NMC devised a safe Nurse-Patient ratio like every other developed country Nursing Professional Registry has done for their fellow colleagues. This leaves Nurses and Midwives with no back-up, basic standards, and minimal requirements. I have seen me on many day having the responsibility to care for 10-12 patients independently (This is not safe). In the US, the maximum number of patients per nurse is 4,on a bad day 5.This is non-HDU/ICU. This is a regular ward, but I asked the NMC once on the telephone what they believe to be safe and my answer was well they dont offer such advice. So it is in times like this I wonder what exactly they do for us?

As there are so many Fitness to Practice cases being heard, perhaps consideration could be given to why those staff are allowed to pass their training courses? Mentors ought to be given more support in failing students who are not safe to practice independently, and perhaps that number might be reduced a little.As for increasing the fee, how can they justify that when nurses across the country are facing an indefinite pay freeze? More and more of our income is going towards fuel and food (essential items); where are we supposed to find this expected increase in fee?!

There is no way a fee increase should even be considered. They may find it reduces income anyway as people on the brink of leaving the profession will be pushed over the edge. They need to recover funds from those who have missused them, but if the NMC were a nurse and (if their case had actually been held), they would no longer be practicing. Abolish the NMC, as several others have said they do nothing for nurses and midwives and they are not protecting patients either. They are not fit for purpose. A single regulator for all of healthcare has got to be more cost effective than multiple ones, some of which are clearly not up to the job. There should be no increases in fees until nurses get an increase in salaries. It cannot be justified. No increase should be greater than the pay award percentage.

I agree entirely with all of the above.Some other questions do need asking though. Why have they allowed the number of Fitness to practice cases get so high? This stinks of total incompetance. If we, as Nurses, were to let our workload get so high then we would be getting disciplined or maybe even adding to the 4000 plus already waiting to be judged if they are fit.Does anyone actually think about these people who are waiting to be judged? Some may well be innocent and yet they are kept waiting in these already uncertain times to see what their future holds.When a person is judged to be guilty then why cant they pay for the hearing costs instead of the rest of us?Yes, we do need a governing body but come on, everyone these days is being told that transparency is the way forward. Why then do we never ever find out what our hard earned cash is spent on. What are the entertainment costs for the NMC? What are the expense account budgets like when the NMC travel around the country.We really do need answers before there is yet another rise in the costs.

When I first registered it was for a life time membership, then with a roll over from nursing unions it changed to 3 yearly membership. With such hard times facing all nursing staff it is depressing and disappointing that we are expected to yet again pay for poor management.

So, not only are we expected to take what is effectively a paycut by the government freezing our wages when the cost of living is increasing dramatically but now we are expected to pay even more for the privelege of doing our jobs? Marvellous, so wonderful to see how little we are valued in this country! I have no idea whatsoever why lots of nurses are moving to Australia, Canada and the States! I wonder what it will take before those in power start to appreciate the hard work and commitment that we give and stop undervaluing us!

FtP panals are vital and the need to reduce the backlog is similarly vital to protect the public however like other respondants I find the idea of increasing fees to fund the FtP cases stange when there are ways to reduce the cost of the cases and the overall cost of the NMC. For example can some one explain why the premises of the NMC are in one of the most expensive parts of London and most of the cases are heard in those and other similarly "central" expensive premises. Move the hearing of cases out of London where the cases can be heard in more modest premises or would the heads of the NMC feel put out. Why does the NMC use expensive legal teams to obtain statements from witnesses prior to the cases, there must be a more cost efective alternative. Who is sitting on the panels anyway as I have not seen any indicators that those people are grass roots and not highly paid staff. How much would it cost to train staff in Birmingham, Manchester, Liverpool and the like to hear the cases and not rack up massive expenses etc. Perhaps nurses who have just retired would be a possible source of cost effective panel members. The cost of premises would be reduced also.DO NOT increase fees until the ares of excessive costs have been tackled

FtP panals are vital and the need to reduce the backlog is similarly vital to protect the public however like other respondants I find the idea of increasing fees to fund the FtP cases stange when there are ways to reduce the cost of the cases and the overall cost of the NMC. For example can some one explain why the premises of the NMC are in one of the most expensive parts of London and most of the cases are heard in those and other similarly "central" expensive premises. Move the hearing of cases out of London where the cases can be heard in more modest premises or would the heads of the NMC feel put out. Why does the NMC use expensive legal teams to obtain statements from witnesses prior to the cases, there must be a more cost efective alternative. Who is sitting on the panels anyway as I have not seen any indicators that those people are grass roots and not highly paid staff. How much would it cost to train staff in Birmingham, Manchester, Liverpool and the like to hear the cases and not rack up massive expenses etc. Perhaps nurses who have just retired would be a possible source of cost effective panel members. The cost of premises would be reduced also.DO NOT increase fees until the ares of excessive costs have been tackled

I agree with many of the above comments, and am not sure how I will find any extra NMC fee from an already increasingly stretched budget. If the NMC's role is to protect the public (not us practitioners), then maybe the public (govt) could increase their financing of it? (I know - won't happen in a recession). The services NMC used to provide that I could use as a practitioner e.g. advice line, NMC review, are being cut & I can see the advice/publications online without being on the register.As fees become extortionate, will they introduce a 'non-practising' rate (cf GMC) for people currently out of work, who therefore aren't posing any nursing risk to the public at present?Also, why is there such an increase in FtP referrals? NMC itself has highlighted rise in inappropriate referrals from employers using NMC as an alternative to completing internal processes or supporting staff in workplace (NMC Review 3) plus issues around scapegoating an individual for systemic/organisational issues (same NMC Review). If that is the case, maybe employers could contribute to the increasing NMC costs e.g. when doing registration checks?Unless, as a profession, we are genuinely becoming more of a risk/less professional, I do not understand why we individual practitioners should bear the cost of other systems' failings.

They are not just inefficient and unhelpful. I hold them primarily responsible for the decline of nurse education. The standards for pre-registration document is responsible for the practice documents universities produce which prioritise soft skills in a very vague way. It makes it easy for students who 'talk the talk' to look competent on paper. It then takes a strong mentor to say when practice or knowledge is not up to standard. As a result standards required for students to pass placements is very inconsistent. We need clear guidence on exactly what knowledge of anatomy, physiology, pharmacology, essential care and nursing skills a student nurse should have at each stage of there training.

I totally agree with the above comments...Why on earth, when the BBC have moved to Salford, does the NMC (or are we awaiting ANOTHER costly name change...) have to occupy a very expensive building in a very expensive area?? I bet the staff love the inner London weighting they get! Localise, decentralise and cut costs...They have us over a barrel... if we refuse to pay, we cant work...Thats democracy for you!And it is as ever "what have the NMC ever done for us??"

I don't know who the many "senior nurses" are that the Editor has spoken to who would take on the post of running NMC are, but as a former Director of Nursing who still works in a senior capacity in the Health Service I know of very few of my contemporaries who would want to go anywhere near Portland Place...a very poisoned chalice indeed.

The comment also misses the point and one of the key CHRE recommendations...what you need is a regulator who can run such an orgnaisation as the NMC....they don't have to be a nurse to do it....look at the nurses who have done it and they haven't exactly covered themselves in glory. A chief exec who is properly advised does not need to be a nurse. It would be good if they were, but it is not essential. The post does not involve nursing and they are not the voice of the profession. This is where Dickon Weir-Hughes went wrong. Bear in mind he was Director of Nursing at Barking and Havering - Google that !

Nial Dickson, Cheif Exec of the GMC is not a doctor and Evelynne Gilvarry, Cheif Exec of the GDC is not a dentist...lets stop being tribal and grow up a bit.

Respect for nurses has gone out of the window.. and I believe our regulatory body is to blame. So now we are are expected to pay more.. for what may I ask? Nurses are working in appalling conditions.. not enough qualified staff to maintain safety and quality of care.. contributing more to our pension for less pension and working for longer.. pay freezes.. and now there is a possibility that the agenda for change pay award will be scrapped in favour of regional pay.. which will depend on the wealth of the region you work in.. basically meaning that nurses in poverty stricken areas will earn less! The future of NHS looks more than fragile and is likely to be broken up.. with private companies claiming they can do the job for less.. which will in turn mean forcing nurses pay down! A local private healthcare employer in my area has just offered voluntary redundancy to it's nurses or to accept a pay drop of 50%!! The NMC wanting more money.. that is an absolute joke..!! What we need is a regulatory body who respects the nursing profession and patient care.. both of which I feel is suffering irretrievable damage!

I have yet to find anyone to have a good word to say for the NMC. It is a public shambles and another humiliation for nurses. Good questions are being asked on this thread - why so many FtP cases? Why such a backlog? Why the expensive premises? Why the obvious ineptitude? The backlog is there because too many unfit nurses are being passed as fit to work, the NMC is inefficient to a comical degree, and the parameters for the FtP criteria are foolishly wide. No-one benefits - there is little or no protection for patients, nurses suffer appalling waits for outcomes, and decisions are questionable to say the least. this body is a farce.

There should be NO RISE in fees - not when you see how they waste money!

I was supposed to be a witness in a FtP case and firstly it was cancelled twice - once was our hospitals fault as it was at Christmas and there was no staff to cover eveyone who needed to go.When it was finally re-scheduled they sent me details of a very expensive hotel I was to stay in and return train tickets which were for peak times so were really expensive.

Firstly - what's wrong with a cheap B&B like Travelodge?? This is London we're talking about - I'm sure they have hundreds of Travelodges or the cheap equivalent - I personally wouldn't pay £140 a night for somewhere so why should the NMC use my money to put 5 or 6 people up at that price? Astounding!!Then at the 11th hour they decided they didn't need me as a witness after all - after 2 years of stress and worry and the waste of money as they didn't want the train tickets back to refund - I was fuming angry.

The NMC couldn't arrange a you-know-what in a brewery. They are a waste of money in themselves and they have no clue how to budget which is offensive at a time like this.A fee hike might even persuade me to give up nursing to be honest - what with staffing levels the way they are, the extra stress every day - I firmly believe that 10 years as a nurse is an admirable career!!